Headache & Pain
Acute Abortive Migraine Therapy
Abortive migraine therapy should be used as soon as possible after symptom development for maximum benefit; if abortive therapy is unsuccessful or used more than twice weekly, consider adding prophylactic therapy. Patients with nausea and vomiting may require nonoral medication. For all medications, consider patient comorbidities and contraindications.
A stroke that occurs along with a migraine headache affects more commonly younger women. Overdose of Ergotamine and dihydroergotamine, high dose Oral contraceptives Pills, propranolol, and serotonergic medications are among the most common precipitating factors. The patient should meet the ICHD criteria for migrainous infarction for the diagnosis.
Hemiplegic migraine is a rare form of migraine with aura. Hemiplegia in hemiplegic migraine is an aura symptom i.e. patients experience unilateral weakness in addition to the migraine headache attack
Debilitating and unremitting migraine headache which lasts at least 72 hours and has been refractory to typical abortive therapy
Chronic Migraine Headache
It is a type of headache that occurs on ≥15 days per month for more than 3 months, and has the features of migraine on at least 8 days per month
Migraine Prevention (Prophylaxis)
Recurrent migraine significantly impairs the quality of life and the patient's functionality, despite prompt treatment of acute attacks demands prophylactic treatment to be provided to the patients. Medication should be started on a low dose with adequate monitoring for 2-3 months. The safest drug to use in pregnant is metoprolol. This chapter emphasizes prophylactic treatment in migraine patients and also gives insight into preferred drugs to be used